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Prototype

The artist's rendering of the new Mark O. Hatfield Clinical
Research Center features a sweep of new wings. The initial phase of
construction,
slated to begin at the end of October, includes the demolition of Building
20, several cottages, and approximately 200 trees. At press time,
groundbreaking
ceremonies had been scheduled for Oct. 31.

Staff for new CC office announced

The Office of the Director recently announced the creation
of the Office of Administrative Management and Planning (OAMP), designed
to integrate and coordinate the administrative management support provided
within the Clinical Center while providing a career ladder for CC
administrative
officers (AOs).

In the new office, four senior-level administrative officers
will work with department AOs to coordinate administrative management
services,
which include personnel operations, acquisitions management, and budget.

The new senior administrative officers--Elaine Ayers, Bridget
Macnamara, Lynda Ray, and William Rosano--will each receive primary
departmental
assignments. Linda Linko will continue to serve as the senior AO for nursing.
The goal is a team able to create administrative efficiencies that will
result in cost savings and service improvements in the CC, Gormley pointed
out.

Among the first efforts of the OAMP is the installation of
Visual Status of Funds software, an automated budget tracking and monitoring
system that downloads information from the NIH Central Accounting System.
Other efforts will focus on creating consistent administrative policies
and practices; developing "best practices" and sharing knowledge
among AOs; providing training for career growth and technical expertise;
implementing new initiatives such as use of credit cards; and ultimately
to improve efficiency across the CC.

"Our goal is to provide the administrative support
necessary
to assist the CC in its long-range goal of cost effectiveness and
efficiency,"
says Gormley.

The 1997 theme, "It All Comes Back to You," is coupled with
the train metaphor to symbolize the importance of all HHS employees
"getting
on board" to help others.

"Employees should look at this as an opportunity to share with people
who may not be as fortunate as themselves," says Al Rexroad, deputy
coordinator of the CC campaign.

This year's campaign provides numerous activities in which employees
can participate. A Name-the-Train contest sponsored by the HHS campaign
group garnered nearly 250 suggestions from NIH alone. The employee with
the best name for the campaign train will be recognized by DHHS Secretary
Donna Shalala Oct. 1.

In addition, names will be drawn weekly for the HHS "Vice Chair's
Cookie Raffle," which provides new CFC contributors a batch of cookies
of their choice.

The Oct. 16 NIH kickoff event will include an R&W "Chili
Cook-Off"
with categories including "best," "most original," and
"hottest." Participants should bring their chili to the front
of Building 1 between 10 and 11:30 a.m., with judging at noon. Hard Times
Cafe also will be on hand to sell their own chili.

Other activities include raffles, music compliments of the Federal Focus
Jazz Band, and special appearances that will include Dr. Bear, the mascot
of Children's National Medical Center.

The Combined Federal Campaign allows employees to chose from over 2500
agencies to voluntarily contribute through payroll deductions.

Critical
Care Medicine's work extends
beyond CC walls

Staff of the Clinical Center's Critical
Care Medicine Department (CCMD)
are applying their expertise outside the walls of the Clinical Center.

Recently, staff members have been involved in updating guidelines for
treatment of opportunistic infections in HIV-infected patients; developing
guidelines for evaluating and treating fever in the intensive-care setting;
and organizing the upcoming meeting of the Society for Critical Care
Medicine.

Said Dr. Henry Masur, CCMD chief, "The Clinical Center and the NIH
are taking an important role in synthesizing NIH-funded research and
industry-sponsored
research into practice guidelines that both health-care providers and patients
can translate into practical day-to-day management."

One such effort is the 1997 revision of USPHS/IDSA Guidelines for the
Prevention of Opportunistic Infections in Persons Infected with Human
Immunodeficiency
Virus. Preventing opportunistic infections (OIs), which take advantage of
a weakened immune system, is key to prolonging survival and improving quality
of life for HIV-infected patients. A task force co-chaired by Dr. Masur,
Dr. Jonathan Kaplan of the Centers for Disease Control and Prevention (CDC),
and Dr. King Holmes of the University of Washington, Seattle, and comprising
members of NIH, the CDC, and the Infectious Diseases Society of America
(IDSA), convened last fall here in Bethesda. The task force reviewed new
data concerning the prevention of OIs and determined which recommendations
needed to be changed. Their revised guidelines, which were originally published
two years ago (see CC News, Aug. 1995), were published in June in Morbidity
and Mortality Weekly Report, and will be reprinted in both Annals of Internal
Medicine and Clinical Infectious Diseases. A July editorial in the Journal
of the American Medical Association by the co-chairs drew attention to the
guidelines for that journal's diverse audience.

"The 1995 edition was the first time that all the opportunistic
pathogens were included in one set of recommendations," said Dr. Masur.
"For an individual practitioner to keep up with all this data is almost
impossible, even if they make AIDS their full-time occupation. It was very
important to try to consolidate this information so that it is available
quickly and all in one place."

What's new in the 1997 revision? Recommendations have changed for four
main OIs:

Pneumocystis carinii pneumonia

Mycobacterium avium complex disease

Tuberculosis

Streptococcus pneumoniae infection

The guidelines are presented in an easy-reference table format accompanied
by full-text rationale for the recommendations. Single copies are available
from the National AIDS Clearinghouse, 1-800-458-5231.

Fever management is another area in which CCMD staff have weighed in
with their expertise. "The Society of Critical Care Medicine (SCCM)
is interested in establishing practice parameters in a variety of areas.
One of these is how to evaluate fever in a cost-effective way," said
Dr. Masur. Patients in intensive-care often develop fevers, and numerous
tests are usually done to determine its cause. This gets expensive.

Dr. Masur again chaired a group that compiled a report called "Practice
Parameters for Initiating a Fever Evaluation in Critically Ill Adult
Patients."
CCMD senior fellow Dr. Naomi O'Grady was the group's executive secretary
and lead author. The group also included former CC clinical specialist Debra
Tribett, R.N., and former CCMD fellow Myung Nam, M.D.

The team considered questions such as, What constitutes a fever? How
best do we measure fever? What tests are most useful? What are the relative
risks of various tests? and How much do they cost? Their report, initiated
by SCCM, has been endorsed by the IDSA and the Society of Health Care
Epidemiologists
and will be published this coming winter in Critical Care Medicine. "This
report should establish a consistent and logical approach that intensive-care
units can modify to fit their practice situations," said Dr. Masur.

The third recent area of influence by CCMD staff centers on the annual
meeting of SCCM. Coming up in February 1998, in San Antonio, the meeting
is being organized by Dr. Anthony Suffredini and Dr. Fred Ognibene. "We've
worked for at least two years to develop a program that reflects the exciting
new developments in the science and clinical practice of critical care
medicine,"
said Dr. Suffredini.

"Our clinical and research experience here at the Clinical Center
gives us a broad perspective. We were able to apply that expertise to help
revitalize the content of the annual meeting," he said. A heavy emphasis
will be placed on interactions between basic science and clinical practice.
The program has four tracks:

pulmonary

sepsis/multiorgan failure

cellular and molecular biology

patient care and professional development.

"The topics within each track are timely, and the speakers are experts
who can communicate with a diverse audience. In fact, several Clinical Center
people are speaking," he said. They include: Dr. Robert Danner, Dr.
Peter Eichacker, Dr. Charles Natanson, Dr. Naomi O'Grady, Dr. Henry Masur,
Dr. James Shelhamer, and Dr. Alison Wichman. Drs. Suffredini and Ognibene
will moderate several sessions.

Dr. Masur sums up: "Critical care is a relatively new subspecialty
compared to cardiology, pulmonary medicine, or gastroenterology. Technology
is improving rapidly, and our understanding of the pathophysiology of
life-threatening
illness has improved dramatically. Clinical Center staff have an opportunity
to contribute to advances in basic research and improvements in patient
care and to the dissemination of these advances to practitioners at other
centers. Taking a leadership role in professional societies in terms of
producing practice parameters and organizing national meetings fits into
the vision and goals our department has established." (by Sue Kendall)

Roundtable-- live from the CC

The first CC Roundtable on Sept. 23 featured a panel of NIH experts
discussing
"New Strategies for the Diagnosis and Management of Kidney Cancer:
Recent Advances in Molecular Genetics." It was broadcast live over
the GE TiP-TV Healthcare Network and CenterNet-The Academic Health Center
Network. Preparing for the broadcast were (left to right) Dr. Berton Zbar,
chief of the Laboratory of Immunobiology, NCI Division of Basic Sciences;
Dr. John Gallin, CC director; Dr. Peter Choyke, chief of the uroradiology
section, CC Diagnostic Radiology Department; and Dr. W. Marston Linehan,
chief of the Urologic Oncology Branch, NCI Division of Clinical Sciences.

A mock survey last month included a visit to 13 East. Head nurse Laura
Chisholm (left) reviews unit procedures with Joan Iocono, one of the
consultants
conducting the practice session.

JCAHO's coming!

In preparation for the Joint Commission visit later this month, the
Rehabilitation
Medicine Department developed "JCAHO Jeopardy," which quizzed
staff members on critical areas such as patient care, human resources,
information
management and leadership. "We came up with the idea because we realized
that a review of the materials for the visit would need to be comprehensive
and we felt that this format would make it enjoyable as well as
informative,"
says Bonnie Thornton, chief of the department's occupational therapy
section.

Certain building repairs are on the fast track as the Joint Commission
visit approaches. Among the jobs being handled by the Division of Engineering
Services, NIH Office of Research Services, is replacement of defective
sprinkler
heads with new and improved ones. Marvin Battle takes care of this play-it-safe
job on 11 East. Nate Adams, project officer, oversees the replacements.
index

Disability
awareness

This year's theme, "Ability-The Bridge to the Future," signifies
two basic truths: the need for all employees-including those of us with
disabilities-to prepare for the future by investing in ourselves today and
the need for employers to focus on the abilities of qualified job applicants
with disabilities to meet the increasing need for skilled workers.

Millions of Americans with disabilities were provided a bridge of
opportunity
with the advent of numerous laws. The Civil Rights Act of 1964, Title V
of the Rehabilitation Act of 1973, and the Americans with Disabilities Act
of 1990 established a clear and comprehensive prohibition of discrimination
on the basis of disability. But census data shows that as of 1994, 50 percent
of working-age individuals with disabilities in this country were not working.
Employment is too critical for economic and social independence and for
feelings of self-worth for us to be satisfied with the progress we have
made thus far.

There is a huge, untapped personnel resource in this country that offers
employers the potential to use talents and skills of the most underutilized
labor pool --people with disabilities. For persons with disabilities, however,
the path to the workplace and a rewarding career is often restricted. Obstacles
to social and economic independence may not come from a lack of capability,
skill, or education. Too often, obstacles arise at the critical point when
people with disabilities have been prepared for the workplace, but the
workplace
has not prepared to receive them.

Because the future needs everyone, the CC EEO Office, through the Disability
Employment Program Coordinator, can help. Remember, ability is the bridge
to the future. Working together, we can ensure that persons with disabilities
successfully navigate the bridge.

From the director

by Dr. John I. Gallin, CC director

October promises to be a busy and historic
month for the Clinical Center.

CC departments are working together and with the institutes to prepare
for our accreditation survey by the Joint Commission on Accreditation of
Healthcare Organizations, which is set for later this month.

This top-to-bottom scrutiny offers us all the opportunity to spotlight
what we do best, which is to provide the highest quality patient care in
a clinical research environment. The survey team will review our policies
and procedures, visit patient-care units, and talk with employees representing
all aspects of CC operations. I am confident that the hard work of all involved
in the preparations will result in a successful survey.

As this issue of CCNews goes to press, groundbreaking ceremonies for
our new Clinical Research Center (CRC) are scheduled for Oct. 31, the day
after the Joint Commission survey ends. Senator Mark O. Hatfield, for whom
our new facility will be named, will be on hand for this event.

I hope that as many Clinical Center employees as possible are able to
participate. Details about the ceremony will be available soon.

The CRC design team is hard at work refining plans for our new facility.
To ensure that the final design meets the needs of the NIH clinical research
programs, the CC Advisory Council has coordinated a series of meetings to
articulate the needs and visions of the individual institutes, centers,
and divisions, which will be incorporated into the final plans.

The results of these reviews will be presented to NIH Director Dr. Harold
Varmus and the ICD directors this month.

Finally, I'd like to extend a welcome to medical and dental students
from across the country who make up the charter class of the new Clinical
Research Training Program here at NIH. Patterned after the Howard Hughes
Medical Institute-NIH Research Scholars Program, its primary goal is to
provide the nation's medical students an NIH venue for exploring clinical
research.

The program was suggested last fall by the clinical research panel that
advises Dr. Varmus about ways to stimulate interest in clinical research.
Nine third-year students joined this first class and most will reside in
the newly renovated NIH Director's House. Part of the students' experience
will be participation in the fourth generation of the Clinical Center's
introductory course in clinical research, which will run October 7, 1997-June
2, 1998.

Dr. John Doppman (right), acting chief of the Diagnostic
Radiology Department, has received the Distinguished Clinical Teacher Award.
Presented annually since 1985, the award recognizes excellence in clinical
training involving the direct care of patients by any senior clinical
investigator
at NIH. Dr. John Gallin, CC director, presented the award.

Celebrate Patient Escort Services

The Outpatient Department will celebrate National Patient Transportation
Week Nov. 3-7. Activities include a raffle benefitting the Patient Emergency
Fund.

Tickets can be purchased outside the special events office from 9 a.m.
to 2 p.m. on those days.

News briefs

Board to meet

The Clinical Center Board of Governors is set to meet on Oct. 22 in the
Medical Board Room. The session is scheduled to begin at 9 a.m.

Director's award ceremony set

CC employees will be recognized for outstanding service during the annual
CC Director's Award Ceremony. This year's program will take place at 2 p.m.
on Nov. 14 in Masur Auditorium.

Rehab Medicine hosts walk

In honor of Physical Therapy Month, the Rehabilitation Medicine Department
will host a one-mile, campus-wide walk on Oct. 21 from 11:30 a.m. to 12:30
p.m.

CC therapists will be on hand to provide information on the benefits
of a regular exercise program and will assist participants by monitoring
their pulses and calculating their target heart rates.

Save your receipts

The NIH Children's School will again this year be collecting receipts
from Giant and Safeway food purchases. Receipts, which will benefit the
school program here at the CC, can be submitted at the Red Cross desk or
sent through NIH mail to Helen Mays, Building 10, Room S235. The program
ends Feb. 28. Call 496-2077 for more information.